Life after diagnosis: Breast cancer treatment, support better by the day

In 1995, Las Crucen Bernadette Valdes was diagnosed with Stage 1 breast cancer. And what clearly stands out to her — and to other Las Cruces women diagnosed in the '90s — about the ordeal was the lack of accessible information about the disease and the lack of support available locally.

That left her feeling bewildered and isolated.

"I had no information, no one to talk to," Valdes said. "I don't know if I had a computer then (for Internet research)."

When Valdes received the diagnosis, a hospital surgeon also told her, matter-of-factly: "Oh, you'll have a mastectomy in two days."

Mastectomy — the surgical removal of one or both breasts — was the first order of treatment back then. And so Valdes went through with it, having both breasts removed. For five years, she also took a preventative drug to stop the cancer's reappearance.

Making strides

October is National Breast Cancer Awareness Month, and health professionals and patients — Valdes included — are lauding the huge strides that have been made in breast cancer treatment and the greater array of options that are now available to patients. In the more than two decades since Valdes' diagnosis, major advancements have been made in research and cancer treatment. Mastectomy — while it still may be a woman's best option, based off her situation — is not the only way to treat the disease, local oncology nurses said. There are often other, less-drastic, less-invasive methods.

For Valdes, who happened to be a board member of Memorial Medical Center's foundation at the time of her diagnosis, the lack of information and resources available to her spurred her into action. She spoke with other foundation board members about her struggle. And they told her they'd back the creation of a new support group for women with breast cancer — if Valdes could manage to gather 20 patient signatures in support of it. It turned out to be a somewhat difficult task. She'd stand by the hospital entrance, asking passersby to lend their support. But there were a lot of rejections.

"Some people thought (because) I had a disease and they didn't want anything to do with me — whether they were Hispanic, Anglo, female, male — whatever," she recounted.

Valdes persevered and collected the required signatures, forming the hospital's first-ever breast cancer support group. The volunteer-led group, which meets once a month, recently celebrated its 22nd anniversary in September. Valdes, the co-chair, said she doesn't want other breast cancer patients "to go through what I went through," the reason she's continued her involvement through to the present day. She also sees the group as a way to give back to her hometown.

"I was looking to help somebody else in this community," she said.

'There were no options'

Longtime support group member Josephine Wiskowski is approaching the 28th anniversary of her breast cancer diagnosis. Like Valdes, she recalled the whirlwind process. There was only one course of action available. She had a biopsy confirming the diagnosis. She recalled the doctor told her: "Oh, you have cancer, and this is what we're going to do."

"And that's it," Wiskowski said. "Then he walks out. There were no options."

Two weeks later, she underwent a double mastectomy.

The monthly support group, in addition to providing a camaraderie for breast cancer patients and their family, regularly hosts presentations about wide-ranging aspects of breast cancer care and general health. Through her participation in the group, Wiskowski has been able to learn about the advancements in breast cancer care. And she's amazed.

"Now, you have so many options," she said. "It's just a different world when I come to these meetings."

Lynn Van Pelt Fletcher, the director of Memorial Cancer Center, said she's often encountered women who, upon getting a breast cancer diagnosis, want a mastectomy as soon as possible. But, depending upon a person's medical case, there are often other options for successful treatment — unlike a few decades ago.

"If you have cancer of the leg, would you cut your leg off?" she said. "Would you remove your arm?"

For instance, lumpectomies — a surgery to remove only the cancerous tumor and a small amount of surrounding healthy tissue — are often a possibility. Sometimes, an oncologist will recommend that chemotherapy be administered to shrink the size of the tumor before the surgery.

Even in cases in which a mastectomy is carried out, the risk for breast cancer isn't entirely eliminated, Fletcher said.

What causes breast cancer?

About one in every eight women in the United States will be diagnosed with breast cancer in her lifetime, according to the National Breast Cancer Foundation. It's the most commonly diagnosed cancer in women and is the second-leading type of cancer deaths among women.

There's a long list of risk factors affiliated with breast cancer, many of which are out of a woman's control, according to the Centers for Disease Control and Prevention. Those include age, inherited genes (mutations in the BRCA1 and BRCA2), having dense breasts comprised of more connective tissue than fatty tissue, and a family history of breast cancer. Other risk factors within a person's control include obesity and drinking alcohol.

Though a woman may have a gene identified with higher breast cancer risk or a history of cancer risk in the family, that doesn't mean she'll necessarily develop breast cancer, said Susan Minsaas, director of oncology at MountainView Regional Medical Center. A common misconception, she said, is "My mother had it, I'm going to have it. Or, My mother didn't have it, I'm not going to have it." But that's not a guarantee.

It's important for women to discuss family medical history and lifestyle factors with their family doctor or gynecologist, Minsaas said.

Health experts said women can undertake a monthly breast self-exam to look for any changes.

Changes in breast appearance and feel should be noted. Women should look for "any lumps or bumps new for you," as well as any skin irritations or dimpling, Minsaas said. Redness or drainage from the nipple also can be red flags.

"These are things you want to have your doctor check," she said.

A doctor may choose to follow up with a mammogram for any breast changes reported by a patient that raise a red flag.

Men face risk, too

Breast cancer, like other cancers, begins when normal cell division in the body goes awry. Left unchecked, a tumor can grow, and cancer cells can spread — or metastasize — to other places in the body.

About 33 out of 100,000 women in the U.S. will die from the disease in 2018, according to cancer.org.

There's also a slight risk for men contracting breast cancer because they also have breast tissue. About 480 men will die nationwide from the disease this year.

"Everything about men's breasts is the same — it's just less of it," Fletcher said.

Cancer in the breast most often starts in what are known as "lobules" (the milk-producing tissues) or in the milk ducts, according to the NBCF. These are known as lobular carcinoma and ductal carcinoma, respectively. Less frequently, the disease afflicts the fibrous and fatty "stromal" tissue of the breast.

Jennifer Ryder Fox of Las Cruces was diagnosed in May 2017 with breast cancer after a red flag first cropped up during a preventative mammogram. She was aware she had a risk factor: dense breast tissue. But she said it was difficult, psychologically, to accept the diagnosis.

"I was convinced I didn't have cancer — even though I had the screening mammogram, the diagnostic mammogram and the biopsy, I was convinced it wasn't happening," said Ryder Fox, another support group member.

Several other breast cancer survivors agreed that denial is a common response to receiving the shocking diagnosis.

But as the realization set in, Ryder Fox delved wholeheartedly into treatment. She opted to seek care at MMC's cancer center — versus traveling to a hospital in another city, as some patients do — after learning about its rigorous credentialing. The first doctor she saw was a surgeon who inserted a "port" into her skin. It's a small metal or plastic disc that allows for the injection of chemotherapy. The surgeon left her confused about her likely course of treatment — communication, she said, could be improved upon — and directed her to an oncologist.

The oncologist gave her an option about how to proceed: She could undergo chemotherapy before her lumpectomy or afterward. But, while she had a choice, he recommended the former.

Ryder Fox also had a choice about the strength or toxicity of chemotherapy to receive. She chose the greater toxicity level — something she doesn't regret. It turned out the cancer was more extensive than doctors first thought and had spread to some nearby lymph nodes.

"If I had not taken the most rigorous chemo — and it knocked me on my butt — I would be second-guessing always: What if I had done the stronger one?" she said.

The first lumpectomy didn't remove all of the cancerous growth — a disappointment to Ryder Fox.

Experts said surgeons, when carrying out a lumpectomy, attempt to cut out a margin of healthy cells around the cancerous ones. That reduces the risk of the tumor re-growing from any left-behind cancer cells.

Ryder Fox had another choice at that point: She could opt for a mastectomy or a second lumpectomy, also known as a "re-excision." She chose the latter, which was successful. The surgeries left her with a significant scar.

"What surprised me is the surgeon told me: 'I can't see the tumor,'" she said. "I assumed it was a piece of necrotic tissue just sitting there and ready to be taken out."

Rather, the size and location of the tumor are pinpointed via imaging. And a procedure called needle-wire localization — in which a needle is used to precisely locate the cancer — takes place before surgery.

When to get a screening

Screening mammograms and when to get them has been a topic of national and international debate in recent years. Many breast cancer organizations and health professionals still advise screenings to take place.

According to cancer.org, women age 40 to 45 "should have the choice" to start annual mammograms, while women ages 45 to 54 should get them every year. Women 55 and older can switch to mammograms every two years or continue the once-a-year screening.

Encountering a 'do-gooder'

By January of this year, Ryder Fox had wrapped up chemotherapy treatments and was set to start radiation in February. She was visiting the MMC cancer center with her husband for a periodic checkup, when she noticed a woman in the lobby folding pamphlets. Her initial thought was cynical: "There's some do-gooder volunteering at the cancer center; isn't that wonderful."

But as Ryder Fox checked in, her husband went to talk to the woman. It turned out to be Valdes, who was prepping materials for an upcoming support group meeting. Ryder Fox's husband had happened to recognize Valdes as someone he'd attended art school with in the 1970s. Before long, Valdes was inviting Ryder Fox to the next meeting.

Ryder Fox admitted she wasn't enthusiastic about the idea.

"I'd thought to myself, I don't need to go to a breast cancer support group because it's just going to be a bunch of women sitting around moaning about 'Why me?'" she said. "That was kind of how I justified it in my mind that I didn't need the support group."

But Ryder Fox soon learned about the topic of January's meeting: radiation. She hadn't yet begun her radiation treatment, and wanted to find out more about what to expect. She's gone back ever since, only missing a few meetings because of travel.

Wiskowski, a breast cancer survivor and longtime meeting attendee, said people often think the sessions are going to be full of doom and gloom. But they're the opposite. She recounted the time when a breast cancer patient once stopped at the door, unsure whether she wanted to attend for the first time. But, after seeing from a distance the other attendees laughing with one another and drinking coffee, her reservations disappeared.

Life as a survivor

Rosalinda Gonzalez of Las Cruces was diagnosed with breast cancer in 2001. She's a nurse herself, and can remember seeing the medical images of the disease.

"It was white," Gonzalez said. "It was in the ducts, so it was spread out."

Gonzalez, too, experienced shock. Throughout the treatment process, she benefited from her sister's support, as well as encouragement from her co-workers. Her sister accompanied her to all of her medical appointments and was by her side in the exam room. When Gonzalez's doctor would discuss the details of treatment, Gonzalez wouldn't remember much of it. But her sister would rehash the information.

Indeed, several breast cancer patients recommended anyone going through treatment have a family member or friend attend exams and checkups as a sort of advocate. It's also a good idea to take notes, they said.

In addition to surgery, Gonzalez underwent four rounds of chemotherapy. She didn't have radiation. For six years afterward, she also took drugs aimed to prevent the cancer's reappearance. Seventeen years later, she's still cancer-free. But she admits that even small pains in her body trigger her to thinking: "Is it coming back?"

"That's always in the back of your mind," she said.

Because of the recommendation of a family member, Gonzalez began attending the support group meetings. She said the group has been "phenomenal."

Ryder Fox, meanwhile, is participating in a clinical trial, taking a certain drug to gauge its effectiveness at preventing recurrence of breast cancer. Breast cancer treatment has gained so much ground because women in the past participated in similar trials, she said. And she's grateful for the opportunity.

Raising funds for research

Fletcher also happens to be board president of Cowboys for Cancer Research — a group that for decades has raised money to fund cancer research.

The organization hosted its 36th annual Cowboys for Cancer Research Team Roping in mid-September. That was preceded by a golf tournament in late August. The group's yearly dinner and dance is slated for Oct. 5 at the Las Cruces Convention Center.

Tickets for both events are $100 apiece and are available at Horse N Hound Feed N Supply, 991 W. Amador Ave. Tickets for the dance only are $10 apiece and can be purchased at the door. The dance, featuring the Delk Band, starts at 8:30 p.m. that day.

Fletcher said the group's fundraising benefits a variety of cancer research. But some of the funds raised helped researchers at New Mexico State University and the University of New Mexico to identify a new gene that's a risk for breast cancer.

Breast cancer risk factors

• Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.

• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram.

• Personal history of breast cancer or certain non-cancerous breast diseases, such as atypical hyperplasia or lobular carcinoma in situ.

• Family history of breast cancer

• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts before age 30 are at a higher risk.

• Women who took the drug diethylstilbestrol (DES), given to some pregnant women in the U.S. between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

Risk factors that can be changed:

• Not being physically active

• Being overweight or obese after menopause.

• Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.

• Reproductive history. Having the first pregnancy after age 30, not breastfeeding and never having a full-term pregnancy can raise breast cancer risk.

• Drinking alcohol. A woman's risk for breast cancer increases with the more alcohol she drinks.